| NPI | 1679186134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401419468) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D010803) |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2025-06-17 |